| NPI | 1790816486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 0003817) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 48303) |
| 106H00000X Marriage & Family Therapist (Licence: CO 871) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-04-28 |